Provider First Line Business Practice Location Address:
307 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47542-1344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-683-5555
Provider Business Practice Location Address Fax Number:
812-683-1111
Provider Enumeration Date:
01/31/2007